Maternal Disease Flashcards
Bad fetal SFX thiazide
Thrombocytopenia, electrolyte
Bad fetal SFX ethacrynic acid
Ototoxicity, HTN
Bad fetal SFX furosemide
PDA (stimulates PGE2 synthesis)
How to make them worse?
- Eisenmenger
- Aortic stenosis
- Mitral stenosis
- IHSS
In order…
- HypoTN (need to keep pressures > pulmonary)
- HypoTN (need the preload)
- Fluid overload, tachycardia
- Tachycardia
Refractory VTach treatment
Amiodarone then defibrillate then (maybe) lido
Refractory maternal SVT treatment
CCB / beta blockers then adenosine then pace
Preeclampsia heme changes.
What increases?
What decreases?
- INCREASE
- Platelet production, platelet activation, TXA2 (which is supposed to activate platelet aggregation and yet…)
- Endothelin. Cellular fibronectin, GF, VCAM-1, Factor 8 antigen, thrombomodulin.
- Ischemic placenta => shoots sFlt-1 (VEGF antagonist) into the circulation
- DECREASE
- Platelet aggregation. Why?
- Exhaustion
- Count overall
- Prostacyclin (PGI2) (which is an aggregation inhibitor so decrease of inhibitor should see more but nope because of previous bullet)
- Nitric oxide
- Anti-thrombin III, Angiotensin II [though activity of them increased; see below]
- Renin, Aldosterone, GFR, Na and Cl in urine.
- Platelet aggregation. Why?
What happens to Antithrombin III and Angiotensin II in PreE?
Antithrombin III levels decreased.
Angiotensin II same-ish but increased sensitivity => vasoconstriction.
What LDH/AST ratio predictive of HELLP over TTP? (Low or high)
LOW = less hemolysis more LFT elevation = HELLP.
Eclampsia timing
- 50% week 20-30
- 20% intrapartum
- 21% postpartum (and of these 90% will be w/in 7 days)
Highest asthma risks in pregnancy
PreE, IUGR = 15%
Ristocetin-cofactor result and why for…
- vWD
- Bernard-Soulier
- Glanzmann
- Wiskott-Aldrich
- Low levels/quality vWF; abnormal.
- vWF receptor deficiency; abnormal.
- Integrin defect. NORMAL result!!
- Defective platelets + eczema. Abnormal.
Inheritance vWD Type 1, 2, 3
AutoD (80%)
AutoD
AutoR
vWD treatment options
DDAVP increases f8 and vWF by 3-5x baseline in 30-60 min.
Also vWF, FActor 8, cryo
Electrophoresis result for beta thal minor / intermedia / major?
80-90% A, 5-10% A2, maybe F
In between; maybe 20-40% F
NO A. Variable A2. Basically ALL F.
Alpha thal cis/trans ethnicities
- Alpha Thalassemia
- Blacks: trans
- Asians: cis
What is Factor XIII deficiency assoc with?
- AutoR. XIII: persistent even fatal bleeding from umbilical stump.
Mechanism of TH storm treatment... Beta blocker Thionamide Iodine Iodinated contrast Glucocorticoids Bile acid sequestrant
Beta blocker Decreases adrenergic tone * If severe asthma and want to avoid BB, can use CCB (diltiazem) Thionamide Decreases synthesis Iodine Decreases RELEASE of Th hormone Iodinated contrast Decreases peripheral conversion Glucocorticoids Decreases peripheral conversion + correct adrenal insuff Bile acid sequestrants Reduce recycling TH
Fetal effect of maternal HyperPTH?
IN utero hypercalcemia.
=> Fetal PTH is suppressed = BONES not calcified
Plus gest hypocalcemic once born
DDx neonatal hypocalcemia
- EARLY
- Prematurity
- Maternal DM
- Birth asphyxia
- IUGR
- LATE
- HypoPTH (can be due to DiGeorge — CATC-H = hypocalcemia)
- High phosphate intake [bovine milk]
- HypoMg
- Vitamin D deficiency
Maternal hypOparathyroidism. Fetal effect?
Neo HyperPTH, bone demin, IUGR, skeletal fractures, increased Ca.
Mechanisms oral DM Rx? What two mechanisms in common? What unique to glyburide? to metformin?
- BOTH decrease hepatic glucose and increase insulin sensitivity
- Glyburide also stimulates beta cell release
- Metformin also decreases intestinal absorption
Breastfeeding and... Active TB? Active VZV? CMV? Hep B? C? Hep A? Syphilis?
- Active TB? Wait 2 weeks on anti-tuberculin therapy before starting to breastfeed
- Active varicella? NO breastfeeding.
- CMV? Breastmilk has both virus and the antibodies. OK!
- Hepatitis B and C? Both in breastmilk (but they get a vaccine for Hep B.
- Hep A not in breastmilk. OK!
- Syphilis not in breastmilk. OK!
HIV CD4 prophylaxis #s and Rx.
PTMC Prophylaxis Takes Much Concentration CD4 < 200 Bactrim for PCP CD4 < 100 Bactrim for PCP and toxo CD4 < 75 Add azithro for MAC CD4 < 50 Add fluconazole for crypto
Viral load and transmission
Viral load > 100k has 30% transmission
< 400 = 1% transmission
Which Rx avoid due to brain malformations (animal)
efavirenz
AZT most common and most severe side effect?
MCC anemia; most severe liver failure
Infection / PTB effect? How?
- Bacteria produce phospholipase A2 and endotoxin
* Phospholipase A2 => PG synthesis
Myasthenia gravis Rx to avoid
- Non-depolarizing muscle relaxants
- Aminoglycosides and several other abx
- Quinine
- Terbutaline, ritodrine
- Magnesium!!
Myasthenia fetal effect:
impaired swallow: poly
decreased FM/breath: pulmonary hypoP
No movement: arthrogryposis multiplex congenita
Neonatal MG
10-15% but won’t show up for 1 week because maternal Rx still in system
Guillain Barre treatment?
Plasmapheresis or high-dose IVIG ideally within the first 1-2 weeks of symptoms (or up to 4 weeks).
Lab changes AFLP
- Increases NH3, uric acid (AKI), LDH, PT/PTT< FDP, bili, LFTs. WBC too.
- Drop in glucose (liver failure), antithrombin III, fibrinogen, plt, H/H
MC complications post-bariatric surgery
- Post-bariatric surgery OB risks
- Cesarean delivery
- (Maybe) PTB
- (Maybe) Growth restriction
Disrupt folate => less of what amino acid?
Methionine
MC vitamin deficiency vegetarians?
B12
Dermatosis of pregnancy assoc w/ Low Ca?
Pustular psoriasis
Highest fetal risk dermatoses of preg?
Pustular psoriasis and pemphigoid gestationis
MC adverse after renal Xplant?
PTB
Pre-renal changes
BUN:Cr
FeNa
Urine Na
- BUN:Cr > 20:1
- FeNa < 1%
- Urine Na < 20
- Osmolality high volume low
Asx bacteriuria occurs in __%
Among these, __% develop pyelo if no tx
5$
40%
Uterine anomalies PTB. Highest risk?
Didelphys > UniC > BiC > Septate
Risk w/ pre w/ IUD in situ?
Chorio (7%) Also PTB (14%) but same whether removed/not.
MC adverse event w/ SLE?
PTB
